Provider Demographics
NPI:1275940058
Name:JERRY DANIEL, MD, MBA, PA
Entity Type:Organization
Organization Name:JERRY DANIEL, MD, MBA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-975-7818
Mailing Address - Street 1:PO BOX 702097
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-2097
Mailing Address - Country:US
Mailing Address - Phone:817-334-0530
Mailing Address - Fax:
Practice Address - Street 1:4020 MCEWEN RD
Practice Address - Street 2:SUITE 177
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-5019
Practice Address - Country:US
Practice Address - Phone:817-334-0530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3000207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty